Healthcare Provider Details

I. General information

NPI: 1780813345
Provider Name (Legal Business Name): RAYMOND WALTER COPP PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 SPRING OAK DR
WEST CHESTER PA
19382-1757
US

IV. Provider business mailing address

564 SPRING OAK DR
WEST CHESTER PA
19382-1757
US

V. Phone/Fax

Practice location:
  • Phone: 610-639-1082
  • Fax: 610-429-9939
Mailing address:
  • Phone: 610-639-1082
  • Fax: 610-429-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberRC60103553
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberHP60107685
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberHYP0000284
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: